The Research Of Multilevel Models In Reproductive Tract Infections Among Rural Married Women Of Childbearing Age

ObjectivesThe main purpose of this study is to explore whether contextual factors of towns,counties and cities have an significant effect on the prevalence of reproductive tract infections and related behaviors among married reproductive women in Shaanxi Province, based on a cross-sectional epidemiology study. The specific purposes are:1. Using multilevel models to estimate the association between the characteristics of lower level (women) and the prevalence of RTIs and related behaviors, such as contraceptives, sexual behaviors and health-seeking behaviors.2. Using multilevel models to estimate the association between the characteristics of higher level (towns, counties, and cities) and the prevalence of RTIs and related behaviors, such as contraceptives, sexual behaviors and health-seeking behaviors.3. Comparing the estimation results between traditional statistical model and multilevel models.MethodsThe methods related to the research purpose include epidemiological quantitative research,bibliometrics, and system review.1. Epidemiological Quantitative ResearchA cross-sectional study were applied to explore the status of reproductive health and influencing factors among married childbearing aged women in rural areas of Shaanxi province. The data was collected using multi-stage cluster random sampling method from July to Oct.,2011. Firstly,20districts (counties) were selected randomly from10cities of Shaanxi Province. Then,80towns (including80administrative villages) were selected from these20districts and counties. Finally,20878married women of childbearing age from20to49years old were selected according to the inclusion criteria.The data was double entered and cross-checked using Epi Data2.1. The weight of the analysis was corrected when calculating the morbidity of RTIs, the incidence of symptoms, the proportions of contraceptive behavior and health-seeking behavior. The analysis was run in the Proc Survyfreq program in SAS9.1.SPSS12.0was used in traditional multivariate logistic regression analysis. The multi-level logistic regression model and multi-level linear regression model were constructed when the contextual variables were added into the model, such as towns, districts and cities. The analysis software was MLwiN2.26.2. BibliometricsThe comprehensive summarize to the epidemiological studies in the last decade were analysised via bibliometrics. The results provided quantitative and objective evidences for the design and analysis of this study.3. The method of systematical evaluationThe literatures included in this study were evaluated systematically, after systematical reviewed and identified, selected. Four subgroup meta analysis were used to evaluate the effect of intervention of health education.The results were analysised using RevMan5.2. SAS programs were used to compute Z value and Nfs0.05.Results1. The methodologies of RTIs literatures in the past ten years179papers are included in the statistical analysis. More than40%of the study has been designed with a stratified cluster sampling method, and more than30%of the studies analyzed the impact factors using traditional logistic regression. There are only2studies using multilevel models.2. The prevalence and influencing factors of RTIs and related behaviorsThe prevalence of RTIs was58.7%. The results of traditional Logistic and multilevel Logistic regression found, the higher age, RTIs history, and more delivery times were the risk factors for RTIs. The education level (OR:1.1760,95%CI:1.0662-1.2971), occupation(OR:0.7970,95%CI:0.7084-0.8966), family yearly income(OR:0.8705,95%CI:0.7869-0.9629), and induced abortion times(OR:1.1961,95%CI:1.0866-1.3167) had significant realtion with RTIs in traditional Logistic model, but these relationships were not significant in multilevel models(P>0.05).The prevalence of RTIs symptoms in the preceding6months was70.0%. The results of traditional Logistic and multilevel Logistic regression found, the higher age, RTIs history, more delivery times and induced abortion times were the risk factors for RTIs symptoms. The family yearly income(OR:0.8568,95%CI:0.7659-0.9584) had significant realtion with RTIs symptoms in traditional Logistic model, but this relationship was not significant in multilevel models(P>0.05). After including the factors of individual level and county level, the relationship between employment rate and RTIs symptoms was statistically significant(P<0.05).60.2%subjects would seek healthcares when RTIs symptoms occured, and28.1%would buy medication themselves. The results of traditional Logistic and multilevel Logistic regression found, the age between30and39, higher education level, higher family yearly income, RTIs history, and more delivery times were the influencing factors for healthcare seeking behaviors. The occupation(OR:1.2163,95%CI:1.0455-1.4150) and induced abortion times(OR:1.1882,95%CI:1.0578-1.3346) had significant realtion with healthcare seeking behavors in traditional Logistic model, but this relationships were not. significant in multilevel models(P>0.05).Female sterilization and IUD were the most prevalent contraceptive methods, the rates were47.3%and34.2%, respectively. The rate of condom use was8.1%. The results of traditional Logistic and multilevel Logistic regression found, the younger age, higher education level, later first marriage age, RTIs history, and less delivery times were the influencing factors for condom use. After including the factors of individual level and county level, the relationship between per capita added value of the first industry and condom use was statistically significant(P<0.05).3. The effects of health education interventionsMeta analysis was applied to the study of15researches,which were divided into4subgroup by the type of study design and evaluation endpoint. The any type of health education can effectively decrease the morbidity of RTIs and improve the RTI knowledge.Conclusions:1. The rural married women of childbearing age are still the high risk population for RTIs. There are nest or cluster structure in most of current studies. The necessary exploration process will be help to choose appropriate statistical models.2. The significant variance of between-high levels in RTIs prevalence and related behaviors implied that, the reproductive health level of women of childbearing age was affected not only by factors of individual and their families, but also by the contexual factors including regional economic, social, and health services.There are differences on influencing factors of the reproductive health of childbearing age women in different districts (high level). Local conditions and the characteristics of the region have to be considered in the RTI intervention policies.Multilevel models have advantages on avoiding type Ⅰ error compared to traditional model for the data with hierachical structure.3. Health education is an easy-designed intervention with effective outcomes. It can be used as a main method to public health improving, RTI prevention and health promotion.